Relative transmissibility of shigellosis among different age groups: A modeling study in Hubei Province, China

Shigellosis is a heavy disease burden in China especially in children aged under 5 years. However, the age-related factors involved in transmission of shigellosis are unclear. An age-specific Susceptible-Exposed-Infectious/Asymptomatic-Recovered (SEIAR) model was applied to shigellosis surveillance data maintained by Hubei Province Centers for Disease Control and Prevention from 2005 to 2017. The individuals were divided into four age groups (<= 5 years, 6-24 years, 25-59 years, and >= 60 years). The effective reproduction number (R-eff), including infectivity (R-I) and susceptibility (R-S) was calculated to assess the transmissibility of different age groups. From 2005 to 2017, 130,768 shigellosis cases were reported in Hubei Province. The SEIAR model fitted well with the reported data (P < 0.001). The highest transmissibility (R-eff) was from <less than or equal to> 5 years to the 25-59 years (mean: 0.76, 95% confidence interval [CI]: 0.34-1.17), followed by from the 6-24 years to the 25-59 years (mean: 0.69, 95% CI: 0.35-1.02), from the >= 60 years to the 25-59 years (mean: 0.58, 95% CI: 0.29-0.86), and from the 25-59 years to 25-59 years (mean: 0.50, 95% CI: 0.21-0.78). The highest infectivity was in <= 5 years (R-I = 1.71), and was most commonly transmitted to the 25-59 years (45.11%). The highest susceptibility was in the 25-59 years (R-S = 2.51), and their most common source was the <= 5 years (30.15%). Furthermore, "knock out" simulation predicted the greatest reduction in the number of cases occurred by when cutting off transmission routes among <= 5 years and from 25-59 years to <= 5 years. Transmission in <= 5 years occurred mainly within the group, but infections were most commonly introduced by individuals in the 25-59 years. Infectivity was highest in the <= 5 years and susceptibility was highest in the 25-59 years. Interventions to stop transmission should be directed at these age groups. Author summary Shigellosis has a heavy disease burden in developing countries. The incidence of shigellosis is highest in children aged under 5 years. The transmission characteristics of shigellosis are unclear in different groups, such as age and occupation groups. In this study, we applied an age-specific mathematical model to analyze data on shigellosis built in Hubei Province from 2005 to 2017. The study found that: 1) Shigellosis transmission in children aged 5 years and under occurred among themselves, but was most commonly transmitted by adults aged 25-59 years; 2) The transmission interaction was greatest between children aged 5 years and under, and adults aged 25-59 years; 3) Infectivity was highest in children aged 5 years and under, and susceptibility was highest in adults aged 25-59 years.